Perimenopause: Why Doesn’t Hormone Testing Work?

Dr. Katherine Bishop, an OB/GYN and NCMP (North American Menopause Society certified practitioner) at the Midlothian location of Virginia Women’s Center, shares why a simple hormone test isn’t a reliable way to determine if a woman is in perimenopause.

The transition into menopause is different for every individual, and each woman has a different set of priorities when it comes to addressing their symptoms. For some, a better night’s sleep may be all they’re after, but for others, their symptoms may be affecting their relationships, body image, self-esteem, and/or mood. We’re here to treat the patient, not a number! ~ Katherine Bishop, MD, NCMP

Navigating the changes in your body during perimenopause can feel like a rollercoaster ride. From mood swings to irregular periods and hot flashes, it’s a journey many women find challenging. As an OB/GYN, I’d like to provide clarity on a topic that often causes confusion: hormone testing for perimenopause.

You may have heard about hormone testing as a way to determine if you’re entering perimenopause, the stage preceding menopause. Perimenopause testing sites are popping up all over the internet and on social media. While it sounds promising, the reality is that hormone testing isn’t the reliable indicator many hope for. Why?

  • Hormone Levels Fluctuate: Hormones, such as estrogen and progesterone, naturally fluctuate throughout your menstrual cycle and even more so during perimenopause. Hormone levels don’t decline steadily over time. This means that a single blood test measuring hormone levels only gives you a snapshot of what your hormones are doing on the day and the exact time your sample was taken. Things could be radically different by the next day. Remember when we said perimenopause can feel like a roller coaster? 
  • Individual Variability: Every woman experiences perimenopause differently. Some may have drastic hormonal shifts and life-altering symptoms, while others may have more subtle changes with minimal symptoms. Hormone testing doesn’t account for this individual variability, making it unreliable as a diagnostic tool.
  • Timing Matters: Perimenopause is a gradual transition that typically lasts four to eight years before menopause officially begins. Hormone levels can vary from month to month, week to week, and even day to day during this time, so a single hormone test will likely not accurately capture where you are in the process.
  • Symptoms Speak Louder: Your symptoms are the most reliable indicator of perimenopause. Irregular periods, hot flashes, night sweats, fatigue, mood swings, brain fog, weight gain, vaginal dryness, change in sex drive, urinary issues, joint pain, and changes in sleep patterns are all common signs. Listening to your body and discussing your symptoms with your healthcare provider can provide more valuable insights than hormone testing alone.

So, if hormone testing isn’t the answer, what can you do?

First and foremost, trust your instincts and pay attention to your body. Keep track of your cycles, your symptoms and how they change over time. This information can help your provider make a more accurate assessment of where you are in the perimenopausal journey. While a clinical diagnosis based on your symptoms may seem low-tech, it’s the most accurate assessment there is at this stage. 

Secondly, maintain open communication with your OB/GYN. Be honest about what you’re experiencing, even if it feels embarrassing or uncomfortable. Your healthcare provider is here to support you and provide guidance tailored to your individual needs.

Lastly, focus on self-care. Eating a balanced diet with plenty of protein and minimal sugar/processed carbs, staying active, especially with weight-bearing exercise to promote lean muscle mass, managing stress, and getting enough sleep can all help alleviate perimenopausal symptoms and support your overall well-being.

So, while hormone testing may seem like a straightforward way to determine perimenopause status, it’s not the reliable solution it’s often promised to be. Instead, trust your body, communicate with your healthcare provider, and prioritize self-care as you navigate this transformative stage of life.

Remember, you’re not alone on this journey. We’re here to support you every step of the way.



Dr. Katherine Bishop loves helping women through the many dramatic physical, mental, and emotional changes in life. Her favorite part of being an OB/GYN is building a relationship of trust with her patients and educating and empowering them to take care of themselves.  Dr. Bishop is a certified menopause practitioner.  She has undergone additional education and training related to the menopausal transition and caring for women with various menopausal symptoms.  NCMP (NAMS Certified Practitioner) certification is performed through the North American Menopause Society (NAMS), a specialty medical society that conducts research and has evidence-based recommendations about menopause.